As a beneficiary of this new-found openness, I do not wish to appear ungrateful. Even so, there’s something about it that unsettles me. When Lisa Snowdon calls her show Midweek Menopause Madness, or the writer Kate Muir describes her “deranged perimenopausal mood swings”, or the actress Martine McCutcheon compares the approach of menopause with “losing your damn mind”, I am desperate to empathise. But I worry about the renewed embrace of the language of craziness to describe being an older woman.

“Thinking about menopause,” wrote Germaine Greer in The Change, “is like thinking about the menstrual cycle: there are two schools of thought”: “One holds that nothing of any significance is taking place, and the other that the stress and strain of what is taking place are so acute that sensible behaviour is not to be expected. Both kinds of arguments conceal crude misogyny. The ‘nothing happening’ school reserves the right to despise women who are encountering difficulties, and the ‘Sturm und Drang’ school allows itself to treat femaleness as a pathological condition.”

In talking about menopause, it seems that we are still in thrall to these two extremes. I fear that in its desire to reject the “nothing happening” state of affairs, which makes women who struggle with menopause feel wimpish and inferior, today’s menopause activism risks going all-out for “Sturm und Drang”. But what about those of us who do not want to be co-opted into this narrative, either?

The legacy of medical misogyny means there is pressure on women to emphasise the severity of symptoms in order to be taken seriously; we have so often been told our pain is “all in our heads”. Yet there is a simultaneous, overlapping history of female emotions — things which are indeed “all in our heads” — being pathologised. Women’s feelings have long been stripped of any social and political context, and therefore treated as purely biological, which makes it easier to apply the label of madness.

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Given the ways in which women’s expressions of anger and anxiety are so often used to discredit us, I question just how liberating some of today’s “menopause madness” rhetoric is. “Some of our negative feelings about menopause,” wrote Greer, “are definitely the result of our intolerance for the expression of female anger.” For many of us, middle age is the first time we feel confident enough to acknowledge the validity of certain emotions. In her 2019 memoir Flash Count Diary, Darcy Steinke describes herself feeling “angry more often, a menopausal condition that doctors classify as hormonal irritability but that I’m starting to see as a gateway to authenticity”. If we see a woman’s expression of anger purely as an unpleasant biological symptom, rather than an acceptance of feelings that she might once have suppressed, we are in danger of undermining her. When I was younger, I was often told that my resistance to male authority was not “normal”, and I believed it. Is it pathological not to believe it anymore?

It is no small thing to tell the world that women your age are going insane, regardless of whether or not you blame this on hormonal depletion. As Elinor Cleghorn writes in Unwell Women, the discovery of oestrogen a century ago did not lead to a straightforward replacement of “old ideas about women being ‘naturally’ defective and deficient”: “Where female nature had, in the past, been blanketed as ‘hysterical’ and ‘neurotic’, now it was hormonal.” Personal accounts in a book produced by campaign group Menopause Mandate, entitled It’s Beyond a Joke, position the benefits of Hormone Replace Therapy as proof that women are not going “properly” mad, yet the distinction seems to me very fine. In the age of Karen, we have not evolved to a stage at which accounts of menopausal derangement can be treated as politically neutral. The shouty middle-aged woman is not taken seriously, regardless of whether she is categorised as mad, bad or simply medication deprived.

I am conscious that, in writing this, I may be accused both of being anti-scientific (because I find the biological realities politically inconvenient) and unsympathetic (because I am having a less extreme menopause than other women). In a piece for The Guardian, Kate Muir claims that “while some lucky women joyously ‘sail through’ the menopause with little more than red clover tea, the reality is that 80% have symptoms — from brain fog to anxiety, depression, sleeplessness, exhaustion, vaginal dryness and stiff joints”. I worry about being perceived as one of these “lucky” red clover tea women — a traitor to the menopausal cause, oblivious to the suffering of her peers.

I do not find this life stage easy. The reason I cringe every time a woman my age seeks to bond over our shared “craziness” is due to my own particular sensitivities. I have spent time as a patient in psychiatric hospitals; the credibility that comes with being perceived as “sane” is not something I treat lightly. I am not prepared to let go of it, in order to feel I am part of the “menopausal club”.

Besides, I am not the only person who finds the evidence base for “menopausal madness” shaky, and not all of us are feminists. Just how many women are having severe menopause symptoms is not a settled matter. Recent research puts those experiencing measurable changes in brain function during menopause at 23%. While this is not insignificant, it does not seem to justify the way in which all women are now primed to suffer from “menopause brain”.

It is also unclear why symptoms differ so much. A 2022 article in the BMJ argued that “social and cultural attitudes contribute to the varied experience of menopause”, and that over-medicalisation risks “collapsing the wide range of experience at the average age associated with this natural process into a narrowly defined disease requiring treatment”. The authors estimated the prevalence of moderate to severe symptoms to be 16-40%, based on a 2021 survey of 11,771 women. They also suggested that women’s expectations and experiences of menopause were strongly influenced by “personal, family, and sociocultural factors”, and by “social values around reproduction and ageing”.

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The article was controversial. Some read in it a puritanical insistence that women should “keep calm and carry on”, despite there being treatments available to alleviate their suffering. To these readers, the authors’ resistance to medicalisation sounded like a return to the “nothing happening” school of thought described by Greer. The debate captured much about the push-pull nature of women’s relationship to medical authority. Are we validated by being labelled, or does validation come when we resist? And what might be the relationship between validation and truth?

My own view is that it is not in the least invalidating to acknowledge that how we feel about our bodies and minds is influenced by how we are told we should feel. Indeed, this is something with which women struggle at all stages of our lives. When teenage girls are described as prone to social contagion, some see in this a claim that their feelings are less real or painful. What I see is that women and girls are always presented with a limited range of acceptable things to express. Right now, “menopausal craziness” is socially and politically forgivable in a way that middle-aged women’s activism regarding other issues is not. This is not to say that hormones or bodily changes are irrelevant, but that the “mad” middle-aged woman is being constructed and discussed using only fragments of an experiential whole.

To be clear, this is not a call to be silent about menopause, or a dismissal of medical intervention when it is part of a holistic view of potential symptoms. Much good has been done in recent years by organisations such as The Menopause Charity and Menopause Mandate. I know women who say Hormone Replacement Therapy has changed their lives, and fully support attempts to make it more accessible and affordable for those who need it. Nonetheless, I resist the tendency to identify as menopausal crazy women. There are enough people in the world who will do this for us; we don’t need to do it to ourselves.

W-3: A Memoir is the result of Bellow’s advice. At first Howland “did not have the energy for such reflections”, but as she recovered she digested, leashed and channelled her misery, observing, like a panopticon, every detail of the ward and its inhabitants: the gangs of student doctors “marching in with their stethoscopes jutting from their pockets”, the “dusty, disabled equipment propped up in corners”, the overflowing ashtrays, the basket weaving, the thin-legged black cleaning staff “thrusting their mops with a strange listlessness”.

Following the book’s publication in 1972, Bette Howland was launched in the literary firmament. Over the next decade she produced two books of short stories and was lauded with prizes, including a MacArthur Genius Award, after which everything went silent. No more publications, no more praise. By the nineties, Howland (who died in 2017) had disappeared altogether and her masterpiece was cast into the oubliette of forgotten books. Then, in 2015, W-3 was found by a literary editor in a dollar box in a second-hand book shop, and a new edition was published this Spring, which is when I discovered it myself.

The timing could not have been better: the world of Covid-19, with its regulations and mayhem and the way in which it has turned us all into inmates is just like W-3. Howland’s memoir is a metaphor for the pandemic. “Let me explain right away,” she says of W-3, “that I didn’t belong here. But that goes without saying, no one belonged here.” This alone might serve as the epigraph to the last 18 months, during which none of us has belonged in the place in which we found ourselves, which for many has been in front of a screen, staring all day at our own distorted visages.

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The patients in W-3 belonged to a tight “community” in a large teaching hospital, itself a unit of a sprawling gothic university, which also happened to be where Howland, before her suicide attempt, had worked as a part-time librarian. Now a full-time member of the institution, Howland found herself, like a Russian doll, occupying less and less space in her own life. Sound familiar?

The first thing she noticed about W-3 was that despite being told there were “no rules”, the “air was thick with them”. There were rules everywhere, attached to everything. The rules came mostly from above, but the patients ruled themselves in after-dinner meetings where they requested various freedoms, such as permission to take a bus journey or to meet up with a friend.

In Howland’s first meeting in W-3, Sydney is chairman and Fran is secretary. “Fran read the minutes very loud and fast, holding the notebook up so I could see her black eyes moving. She wore a shower cap over her curlers; coarsely graying hair.

‘Any additions or corrections?’ she asked in a challenging voice.

‘Actually, I think I’m supposed to say that,’ Sydney said, glancing at the notes of parliamentary procedure he was crushing in his fist’.”

No one has anywhere else to go or anything else to do, and meanwhile Trudy keeps interrupting:

“‘Hey! I’ve got another question! When do I get to talk?’

‘So far,’ Sydney observed, ‘you’ve been doing more talking than anybody else’.

‘Oh fuck. Fuck you. I know all about these meetings. Don’t worry, I’ve been to plenty of meetings. I bet I’ve been in more nuthouses that you have. So you don’t have to go getting stuck up with me about your dumb meeting!’“

These community meetings are not unlike what I imagine the Cabinet meetings to have been like during the recent crisis: Boris Johnson, with his “go to work, don’t go to work” directive, might have been schooled in W-3.

But they are even more reminiscent of the Extraordinary Meeting of Handforth Parish Council, called by two councillors “following the refusal of the council chairman to call such a meeting,” which went viral in February. Remember Jackie Weaver being told ‘to “read the standing orders! Read them and understand them”?  All zoom meetings are like nuthouses. You have no authority here, Sydney.

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Howland also noticed that in W-3, despite the amount of time spent grooming themselves, “everyone looked essentially the same — peculiar”. The inmates kept up appearances while looking dreadful. The women, like “birds in a barnyard,” wore clownish quantities of make-up: black eyebrows, red cheeks, “eyelids like wilted butterfly lids”. Hair, which always looked “wrong”, was controlled by tongs, towels and wigs. The kitchen smelt of burning hair; even the cleaning staff wore wigs. One wig, crooked and silky black, rested on a patient’s head “like a roosting wing.”

“Clothes”, however, were the focal point of the female patients. “On W-3, all inmates were expected to wear ‘clothes'”, and “clothes” meant anything that was not hospital garb. One woman swished down the corridors in a sleeveless evening gown and a single opera glove, because self-care proves you are still sane.

I read W-3 while lying in my pyjamas. Like many people, I wore pyjamas all day throughout the pandemic because lockdown meant “no rules” as well as nothing but rules. I would have worn a wig if I had one. Like other women in my neighbourhood community, I accessorised my bedclothes when I exercised the dog. Feathers in our greying hair, bangles on our wrists and slippers on our feet, the dog-walking sorority circled the local park, shouting through our masks while waiting for our animals to bend their legs and shit.

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When I met my Creative Writing classes on Zoom, I put on a jumper in order to look sane. My students, on the other hand, kept their cameras off so that no one could see what they were wearing or where they were living or who they had reverted to being. They too were occupying less and less space in their own lives, most of them now spending 24 hours a day in their childhood bedrooms, beneath faded Snoopy duvet covers and the florescent stars their mum put on the ceiling 15 years ago to help them sleep at night. In emails to me they described despair, depression, deepening levels of panic as their debts accumulated and their worlds closed in. For four solid terms I talked to row upon row of black squares, an oubliette of forgotten people.

The only student to put on her camera was a girl who sat up in bed in a negligee as though caught unawares on camera. Ready for her close-up, she wore full make-up: orange foundation, false eyelashes, big pink lips, her hair coiffured to within an inch of its life. There was a connection, I thought, between the excessive performance of presence in W-3 and in this student’s bedroom, and the otherwise excessive performance of absence in the seminars. When the whole community is sick, on-stage and off-stage become versions of the same thing.

“Cook and eat your misery,” I counselled my seminar groups, just as Bellow counselled Bette; harness your ward and its inhabitants. One or two of them did, but for the most part they lacked the energy for such reflections. The bulbs had all blown leaving nothing but darkness. Except, as Bette Howland said of her own state, “it wasn’t dark — it wasn’t anything”.